Introduction and Objective: Post-pancreatitis diabetes mellitus (PPDM-C) is characterized by dual exocrine and endocrine failure. However, the impact of exocrine insufficiency (PEI) on β-cell reserve and glycemic variability remains underdefined. This study aims to elucidate the characteristics of islet function in CP and the influence of exocrine status on glucose homeostasis.Methods: We analyzed 148 CP patients using Mixed Meal Tolerance Tests (MMTT) and Continuous Glucose Monitoring (CGMS). Patients were stratified by glucose tolerance (NGT, IGT, DM) and fecal elastase-1 (FE-1) levels. We assessed islet function using HOMA indices, Insulinogenic Index (IGI), and Corrected Insulin Response (CIR), and glycemic variability via MAGE and Time in Range (TIR).Results: 1. Baseline & Endocrine Phenotype: While BMI was comparable across groups (P>0.05), HOMA-β and early-phase secretion (IGI, 30min C-peptide) significantly declined from NGT to DM (P<0.001). Notably, HOMA-IR showed no significant difference among groups (P>0.05), indicating a defect in reserve rather than insulin resistance.2. Exocrine-Endocrine Correlation: In patients without decompensated diabetes, FE-1 levels showed a significant positive correlation with IGI, CIR, and HOMA-β (P<0.001). Patients with severe PEI exhibited significantly higher FPG and glucose AUC compared to those with normal exocrine function (P<0.05).3. Glycemic Variability: FE-1 levels were negatively correlated with MAGE (P<0.05). Regression analysis confirmed that PEI is an independent risk factor for increased glycemic variability and reduced TIR, even after adjusting for insulin secretion.Conclusion: PPDM-C is primarily driven by insufficient β-cell reserve, specifically impaired early-phase secretion. This endocrine dysfunction parallels the severity of exocrine insufficiency. Thus, exocrine function is a key determinant of glycemic stability, highlighting that exocrine assessment and intervention are essential for optimal glycemic management in CP patients.
R. Wang: None.
Source link
Leave a Reply